UEG's content platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

Re-live UEG Week 2026 on Gutflix Gut Guide online What's new on Gutflix

Trending on Gutflix

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Presentation

New

RISK OF AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER-LIKE PHENOTYPE IN CHILDREN WITH CELIAC DISEASE: A NATIONWIDE POPULATION-BASED COHORT STUDY

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

RISK OF AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER-LIKE PHENOTYPE IN CHILDREN WITH CELIAC DISEASE: A NATIONWIDE POPULATION-BASED COHORT STUDY

Jialu Yao 1, Lisa Dinkler 1, Jiangwei Sun 2,1, David Bergman 1, Peter HR Green 3, Elisabet Wentz 4,5, Mariel Arvizu 6, Benjamin Lebwohl 3,7, Jonas F Ludvigsson 1,3,8

Affiliations

1 Karolinska Institutet, Solna, Sweden

2 Sun Yat-sen University, Shenzhen, China

3 Columbia University College of Physicians and Surgeons, New York, United States

4 University of Gothenburg, Gothenburg, Sweden

5 Sahlgrenska University Hospital, Gothenburg, Sweden

6 Takeda, Cambridge, United States

7 Columbia University, New York, United States

8 Örebro University Hospital, Örebro, Sweden

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Children with celiac disease (CeD) may face an increased risk for avoidant/restrictive food intake disorder (ARFID, first defined in the Diagnostic and Statistical Manual of Mental Disorders [DSM]-5 in 2013) due to generalized fear of adverse consequences associated with gluten exposure. However, population-based evidence linking CeD to the development of ARFID is lacking.

Aims & Methods

To investigate the risk of incident ARFID-like phenotype before adulthood in children with CeD. Children (≤16 years) with biopsy-confirmed CeD from 2001 through 2022 were identified from a Swedish nationwide histopathology cohort "ESPRESSO" (n=13,576) and matched with ≤5 reference individuals from the general population (n=66,068) by sex, birth year, calendar year of diagnosis, and county of residence. ARFID-like phenotype was identified in the Swedish National Patient Register via the tenth revision of the International Classification of Diseases (ICD)-10 codes F98.2 and R63.3 (as an extension of infant or early childhood feeding disorders according to DSM-5, the specific code for ARFID has only been introduced in ICD-11). To mitigate potential detection bias, follow-up started one year after CeD diagnosis or matching until incident eating disorders, or the earliest occurrence of 18th birthday, death, emigration, or 31 December 2023. The adjusted hazard ratio (aHR) was estimated using Cox regression. In sensitivity analyses, we excluded conditions that may cause secondary eating disturbances to increase the specificity for ARFID, and addressed intra-familial factors via comparison with CeD-free full siblings.

Results

Over a median follow-up of 12.6 years, 89 children with CeD had an ARFID-like diagnosis before adulthood, compared to 160 reference individuals (incidence rate: 57 vs. 21 per 100,000 person-years). After adjusting for matching variables, country of birth, parental educational level, and specialist visit frequency, the aHR for ARFID-like phenotype in CeD was 1.70 (95% confidence interval:1.19 to 2.44). In subgroup analyses, the positive association was significant among boys and among those 6-11 years (Table 1). The association between CeD and childhood ARFID-like phenotype became non-significant when excluding conditions potentially causing secondary eating disturbances (aHR=1.36 [0.83 to 2.22]), while was similar when compard to CeD-free siblings (aHR=1.78 [0.96 to 3.31]).

Table 1. Incident ARFID-like phenotype in patients with CeD and their matched reference individuals, stratified by sex, age, and calendar period
ARFID: avoidant/restrictive food intake disorder; CeD: celiac disease; CI: confidence interval; HR: hazard ratio; IR: incidence rate ^aIndex date: one year after CeD diagnosis/matching ^bConditioned on the matching variables (birth year, sex, county of residence, and calendar year of index date) and further adjusted for country of birth, parental educational attainment, number of healthcare visits between two years and six months before the index date
		Patients No. of events (IR, per 100,000 person-years)	Matched reference individuals No. of events (IR, per 100,000 person-years)	IR difference (95%CI), per 100,000 person-years	HR (95%CI) ^b
Age at index date, years ^a	1-5	42 (80)	80 (32)	49 (24 to 74)	1.31 (0.80 to 2.15)
	6-11	37 (67)	58 (22)	45 (23 to 68)	2.32 (1.27 to 4.25)
	12-17	10 (21)	22 (10)	11 (-2 to 25)	1.93 (0.53 to 7.04)
Sex	Female	55 (57)	114 (24)	32 (17 to 48)	1.36 (0.88 to 2.11)
Sex	Male	34 (58)	46 (16)	42 (22 to 62)	2.86 (1.47 to 5.58)
Calendar period at index date^a	2002-2012	53 (43)	109 (18)	24 (12 to 36)	1.59 (1.03 to 2.46)
Calendar period at index date^a	2013-2023	36 (115)	51 (34)	81 (43 to 120)	2.11 (1.03 to 4.32)

Conclusion

Children with CeD, specifically boys and those diagnosed during primary school years, were at an increased risk of developing an ARFID-like phenotype. Clinicians should actively discuss with patients and their families about the mental distress when maintaining a gluten-free diet, and be cautious to avoid hypervigilance when guiding disease management.

Disclosure

MA is an employee of Takeda Pharmaceuticals and owns stock in this company.
JFL has coordinated a study on behalf of the Swedish IBD quality register (SWIBREG). That study received funding from Janssen Corporation. JFL has also received financial support from MSD developing a paper reviewing national healthcare registers and for research on IBD. JFL also has a research collaboration on celiac disease with Takeda.
The other authors report no disclosures relevant to the manuscript.

Event

UEG Week Barcelona 2026

Topics

Endoscopy Small Intestine & Nutrition Immunology

Submission format

Abstract

Session

From modern diagnostics to treatments in coeliac disease

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

Towards prevention: A trinational birth cohort study to unravel modifiable triggers of inflammatory bowel disease

Karl Marild

Hereditary tumour syndromes in transition

Robert Hüneburg

Panel discussion: Advancing endoscopic resections in the colon

RISK OF AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER-LIKE PHENOTYPE IN CHILDREN WITH CELIAC DISEASE: A NATIONWIDE POPULATION-BASED COHORT STUDY

Jonas F Ludvigsson

Pouchitis in ulcerative colitis - management strategies and long-term outcome

Johan Burisch

Introduction: Hot topics in European Gastroenterology

Albrecht Neesse